Analysis of therapeutic plasma exchange combined with continuous venovenous hemofiltration in the treatment of children with severe sepsis and multiple organ dysfunction syndrome / 中华实用儿科临床杂志

Objective:To investigate the therapeutic potential of therapeutic plasma exchange (TPE) combined with continuous venovenous hemofiltration (CVVH) in the treatment of children with severe sepsis and multiple organ dysfunction syndrome (MODS).Methods:It was a prospective randomized controlled study (RCT) involving 70 children with severe sepsis and MODS admitted to Anyang Maternal and Child Health Hospital from February 2019 to February 2023.According to random number table method, they were randomly divided into combination group (35 cases) and CVVH group (35 cases). Patients in the CVVH group were treated with CVVH alone, and those in the combination group were treated with TPE combined with CVVH.The antibiotic use time of the two groups was recorded and compared by the t test.The prothrombin time (PT), thrombin time (TT), partial prothrombin time (APTT), fibrinogen (FIB), and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), high mobility group protein B1 (HMGB1), Toll-like receptor 4 (TLR4) and soluble receptor (sFLT) levels before treatment and 48 h and 72 h after treatment were compared by the repeated measurement ANOVA for the overall comparison at multiple time points, and LSD- t test for pair-wise comparison.The 28-day survival of the two groups was recorded and compared by the Chi- square test. Results:The PT, TT and APTT at 48 h and 72 h after treatment were significantly lower in the combination group than those of CVVH group (all P<0.05). The FIB at 48 h[(2.15±0.42) g/L vs.(1.84±0.31) g/L]and 72 h after treatment [(2.89±0.27) g/L vs.(2.49±0.20) g/L]were significantly higher in the combination group than those of CVVH group (all P<0.05). The duration of antibiotic use in the combination group was significantly shorter than that of CVVH group [(11.33±1.16) d vs.(13.54±1.92) d, t=5.828, P<0.05]. Serum levels of IL-1β, IL-6 and TNF-α at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). Serum levels of HMGB1, TLR4 and sFLT at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). The 28-day survival of the combination group was significantly higher than that of CVVH group (94.29% vs.77.14%, χ2=4.200, P=0.040). Conclusions:TPE combined with CVVH can improve the coagulation function and inflammatory factor levels in children with severe sepsis and MODS, which may achieve therapeutic objectives by regulating the levels of HMGB1, TLR4 and sFLT, and improve the short-term prognosis.

Clinical application of plasma exchange combined with continuous veno-venous hemofiltration dialysis in children with refractory Kawasaki disease shock syndrome / 中国当代儿科杂志

OBJECTIVES@#To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).@*METHODS@#A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.@*RESULTS@#Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.@*CONCLUSIONS@#Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.

Volume management of intermittent hemofiltration guided by critical care ultrasound in the treatment of acute kidney injury / 中华危重病急救医学

Objective:To investigate the volume management of intermittent veno-venous hemofiltration (IVVH) guided by critical care ultrasound in the treatment of acute kidney injury (AKI) in patients with heart failure (HF).Methods:A total of 216 patients with HF and AKI treated with IVVH in the coronary care unit (CCU) of the Third Central Hospital of Tianjin from April 2019 to June 2022 were selected as the study subjects, the patients were randomly divided into conventional guidance group (107 cases) and ultrasound guidance group (109 cases). According to the recovery of renal function, IVVH was performed 12 hours every day or 12 hours every other day. The conventional guidance group selected the conventional method to formulate IVVH prescription, and the ultrasound guidance group used critical care ultrasound to adjust the treatment parameters of IVVH on the basis of the conventional guidance group. Respiratory variation index (RVI) of inferior vena cava (IVC), right left ventricular end-diastolic transverse area ratio, early diastolic peak mitral flow velocity/mitral annulus velocity peak (E/E'), aortic flow velocity time integral (VTI), cardiac output (CO), bilateral lung ultrasound B-line range, bilateral renal interlobar arteries resistance index (RI) were recorded before and 3, 6, 9 hours after each treatment. The net dehydration rate was adjusted in real time according to the comprehensive results. Urine volume, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood B-type brain natriuretic peptide (BNP), β 2-microglobulin (β 2-MG) and cystatin C (Cys C) levels of patients in both groups were monitored before and 3, 7 and 10 days after initial treatment, and renal function recovery and clinical prognostic indexes of patients in both groups were recorded. Results:The dehydration rate of the ultrasound guidance group was slow at the beginning of IVVH, and gradually increased after 6 hours, and the overall dehydration rate was significantly slower than that of the conventional guidance group. In the ultrasound guidance group using critical care ultrasound, the RVI gradually increased, the right left ventricular end-diastolic area ratio gradually decreased, the E/E' ratio gradually decreased, and the range of B-line of bilateral lungs gradually decreased, RI of bilateral renal interlobar arteries decreased. At 3, 7 and 10 days after the first IVVH, renal function related indexes in both groups were significantly improved compared with before treatment, and the decline rate of β 2-MG and Cys C in the ultrasound guidance group was faster than that in the conventional guidance group at early (3 days) [β 2-MG (mg/L): 3.69±1.31 vs. 3.99±1.45, Cys C (mg/L): 2.91±0.95 vs. 3.14±0.96, both P < 0.05], urine volume, SCr and eGFR at 7 days were also significantly improved compared with the conventional guidance group [24-hour urine volume (mL): 1 128.23±153.92 vs. 1 015.01±114.18, SCr (μmol/L): 145.86±32.25 vs. 155.64±28.42, eGFR (mL/min): 50.26±11.24 vs. 46.51±10.61, all P < 0.05]. The time of SCr recovery, the time of reaching polyuria, the total time of IVVH treatment, the time of non-invasive mechanical ventilation and the time of living in CCU in the ultrasound guidance group were shorter than those in the conventional guidance group. The incidences of hypotension, long-term RRT, incidence of major cardiovascular adverse event (MACE) and at 28-day mortality were all lower than those in the conventional guidance group. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the ultrasound guidance group was significantly lower than that in the conventional guidance group (Log-Rank test: χ 2 = 3.903, P = 0.048). Conclusion:The strategy of IVVH guided by critical care ultrasound in the treatment of HF with AKI has unique advantages.

Capacitación en reemplazo renal continuo, primera experiencia en el Sanatorio Allende. Relato de experiencia / Training in continuous renal replacement,first experience at the Allende Sanatorio. Experience report

La Insuficiencia Renal Aguda (IRA), es sin dudas una de las complicaciones más frecuentes que puede presentar el paciente crítico; la cual se define como la disminución en la capacidad que tienen los riñones para eliminar productos nitrogenados de desechos. En las unidades de cuidados críticos la causa de las mismas puede ser multifactorial y se relaciona con el fallo multiorgánico. El presente trabajo es un relato de experiencia, un trabajo descriptivo de experiencias de la terapia en reemplazo renal continuo, acompañado además de recolección bibliográfica, cuyo objetivo principal es la capacitación en el tratamiento de las insuficiencias renales en los pacientes críticos con la terapia de reemplazo renal continuo. Para abordar esta temática, se conformó un equipo multidisciplinario en el mes de Abril del año 2021, entre los servicios de Unidad de Cuidados Crítico y el Servicio de Nefrología, en donde se desarrolló un plan de capacitación de manera virtual para abordar el tratamiento a los pacientes con fallo renal, el cual contó además con la disertación y capacitación de personal altamente calificados en el tema, para posteriormente realizar un entrenamiento teórico-práctico en el servicio de Hemodiálisis del Sanatorio Allende de Nueva Córdoba, en la técnica de conexión y desconexión de catéteres de hemodiálisis, en el cual asistieron un total de 26 enfermeros del área de Terapia Intensiva de ambas sedes con el fin de aprender la técnica específica que se aplicará en los pacientes que serán sometidos a hemofiltración venovenosa continua[AU]

Acute Renal Insufficiency (AKI) is undoubtedly one of the most frequent complications that critical patients may present; which is defined as the decrease in the ability of the kidneys to eliminate nitrogenous waste products. In critical care units, their cause can be multifactorial and is related to multiorgan failure.The present work is a report of experiences, a descriptive work of experiences of continuous renal replacement therapy, accompanied by a bibliographic collection, whose main objective is training in the treatment of renal insufficiency in critical patients with replacement therapy. continuous kidney. To address this issue, a multidisciplinary team was formed in April 2021, between the services of the Critical Care Unit and the Nephrology Service, where a training plan was developed virtually to address the treatment of patients. patients with kidney failure, which also included the dissertation and training of highly qualified personnel on the subject, to subsequently carry out theoretical-practical training in the Hemodialysis service of the Allende Sanatorium in Nueva Córdoba, in the connection and disconnection technique of hemodialysis catheters, which was attended by a total of 26 nurses from the Intensive Care area of both sites in order to learn the specific technique that will be applied to patients who will undergo continuous venovenous hemofiltration[AU]

A Insuficiência Renal Aguda (LRA) é, semdúvida, uma das complicaçõesmaisfrequentes que os pacientes críticos podemapresentar; que é definida como a diminuição da capacidade dos rins de eliminar produtosresiduais nitrogenados. Em unidades de terapia intensiva, sua causa pode ser multifatorial e está relacionada à falência de múltiplos órgãos. O presente trabalho é um relato de experiências, umtrabalhodescritivo de experiências de terapia renal substitutiva contínua, acompanhado de umlevantamento bibliográfico, cujo objetivo principal é a capacitação no tratamento da insuficiência renal em pacientes críticos com terapia substitutiva renal. Para abordar essaquestão, uma equipe multidisciplinar foi formada em abril de 2021, entre os serviços da Unidade de Terapia Intensiva e o Serviço de Nefrologia, onde foi desenvolvido um plano de treinamento virtualmente para abordar o tratamento de pacientes com insuficiência renal, que incluiutambém o dissertação e treinamento de pessoal altamente qualificado no assunto, para posteriormente realizar treinamento teórico-prático no serviço de Hemodiálise do Sanatório Allende em Nueva Córdoba, na técnica de conexão e desconexão de cateteres de hemodiálise, que contoucom a participação de um total de 26 enfermeiros da área de Terapia Intensiva de ambos os locais para conhecer a técnica específica que será aplicada aos pacientes que ser ãosubmetidos à hemofiltração venovenosa contínua[AU]

Effects of sustained low-efficiency dialysis combined with hemoperfusion on routine blood indicators and inflammatory factors in patients with sepsis-induced acute kidney injury / 中国基层医药

Objective:To investigate the effects of sustained low-efficiency hemodialysis combined with hemoperfusion on routine blood indicators and inflammatory factors in patients with sepsis-induced acute kidney injury.Methods:Eighty-six patients with sepsis-induced acute kidney injury who received treatment in Yantai Laiyang Central Hospital from April 2018 to April 2021 were included in this study. They were randomly divided into an observation group and a control group, with 43 cases in each group. All patients received conventional supportive treatment. The control group received continuous renal replacement therapy and the observation group received sustained low-efficiency dialysis combined with hemoperfusion. Before and after treatment, routine blood indicators [hemoglobin (Hb), white blood cell (WBC) count, platelet (PLT) count, albumin (Alb)], inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), procalcitonin PCT)], renal function indicators [serum creatinine (Scr), blood urea nitrogen (BUN)], The Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of hospital stay, and 28-day mortality rate were compared between the two groups.Results:Before treatment, there were no significant differences in Hb, WBC count, PLT count, Alb, IL-6, CRP, TNF-α, PCT, Scr, BUN, and APACHE II score between the two groups ( t = 0.04, 0.95, 0.23, 0.67, 1.54, 0.75, 0.98, 0.23, 1.04, 0.44, 0.07, all P > 0.05). After treatment, serum levels of Hb and Alb in each group were significantly increased compared with those before treatment. After treatment, serum levels of Hb and Alb in the observation group were (105.29 ± 15.80) g/L, (39.25 ± 7.87) g/L, respectively, which were significantly higher than (98.55 ± 12.93) g/L and (33.38 ± 7.29) g/L in the control group ( t = 2.16, 3.58, both P < 0.05). After treatment, WBC count, PLT count, IL-6, CRP, TNF-α, PCT, Scr, and BUN levels, and APACHE II score in each group were significantly decreased compared with those before treatment. After treatment, WBC count, PLT count, IL-6, CRP, TNF-α, PCT, Scr, and BUN levels, and APACHE II score in the observation group were (10.28 ± 1.87) × 10 9/L, (129.32 ± 14.79) × 10 9/L, (59.00 ± 12.77) μg/L, (22.41 ± 5.01) mg/L, (28.41 ± 4.77) μg/L, (18.41 ± 2.78) μg/L, (162.01 ± 21.04) μmol/L, (7.38 ± 1.17) mmol/L, (11.28 ± 3.60) points, respectively, which were significantly lower than (12.32 ± 2.27) × 10 9/L, (137.39 ± 18.30) × 10 9/L, (79.35 ± 14.36) μg/L, (29.31 ± 6.37) mg/L, (34.33 ± 5.38) μg/L, (22.32 ± 3.35) μg/L, (184.06 ± 24.03) μmol/L, (9.87 ± 1.66) mmol/L, (14.65 ± 3.38) points in the control group ( t = 4.54, 2.24, 6.94, 5.58, 5.39, 5.89, 4.52, 8.03, 4.47, all P < 0.05). The length of intensive care unit stay in the observation group was significantly shorter than that in the control group [(11.63 ± 2.18) days vs. (14.07 ± 2.71) days, t = 4.60, P < 0.05]. There was no significant difference in 28-day mortality rate between the two groups ( χ2 = 1.36, P > 0.05). Conclusion:Sustained low-efficiency dialysis combined with hemoperfusion is effective on sepsis-induced acute kidney injury. The combined therapy can improve routine blood indicators, inhibit inflammatory reactions, promote renal function recovery, and decrease the mortality rate to a certain degree.

Effects and significance of continuous hemoperfusion on patients with diquat poisoning / 中华危重病急救医学

Objective:To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance.Methods:A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO 2), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients. Results:Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO 2, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (μg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (μmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO 2 levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ2 = 7.288, P = 0.007]. Conclusion:Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.

Terapia de reemplazo renal continua. Presentación de un caso / Continuous renal replacement therapy. Case report

RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios (AU).

ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results (AU).

Postoperative Acute Kidney Injury and Efficacy of Continuous Hemodiafiltration after Cardio-Thoracic Surgery / 日本心臓血管外科学会雑誌

Background and Purpose : Patients who undergo cardiac and thoracic vascular surgery are known to have a high risk of developing acute kidney injury (AKI). The incidence of post-operative acute renal failure and the utility of continuous hemodiafiltration (CHDF) for acute renal failure following cardiovascular surgery was determined. Subjects and Methods : Of the 321 subjects who underwent cardiac and thoracic vascular surgery accompanied by an open thoracotomy from January 2014 to August 2017, 303 patients were included in this study after excluding those who received maintenance dialysis and those treated with PCPS. Patients were grouped based on the GFR classification of CKD severity (preoperative eGFR values : G1 : ≥90, G2 : <90, G3a : <60, G3b : <45, G4 : <30, G5 : <15) and patient records were retrospectively examined. Results : The total incidence of AKI was 30.7%. In comparison with G1 and G2, the AKI incidence rate was significantly higher (p<0.01) in G3a, G3b, G4, and G5 patients who displayed preoperative renal dysfunction. Upon multivariate analysis, preoperative eGFR values were shown to be a predictor of post-operative AKI avoidance with a cutoff value of 56 ml/min/1.73 m2 (odds ratio = 4.104, AUC = 0.6954). The post-operative CHDF introduction rate was 3.6%. After introduction of CHDF, patient urine volume and body blood pressure significantly increased (p < 0.01). In 2 cases, a rapid increase of urine volume (2.5 ml/kg/h, 1.8 ml/kg/h) was observed within 1 h after the induction of CHDF. Conclusions : A high rate of post-operative AKI onset occurs in cardiac and thoracic surgery cases. Upon early introduction of post-operative CHDF, prompt recovery of renal function and stabilization of circulatory dynamics can be expected.

Technical specification of blood purification in organ transplantation (2019 edition) / 器官移植

In order to further standardize the clinical technical operation of blood purification related to organ transplantation, experts in the fields of organ transplantation and nephrology organized by Branch of Organ Transplantation of Chinese Medical Association have formulated this specification from the perspectives of technical operation specifications of vascular access, hemodialysis, peritoneal dialysis, hemofiltration, plasma exchange and immunoadsorption.

Research advances in continuous blood purification in treatment of severe acute pancreatitis / 临床肝胆病杂志

Severe acute pancreatitis (SAP) is a disease with dangerous course and poor prognosis, and although medical technology keeps improving over the years, the mortality rate of SAP remains high. As the latest achievement in the field of blood purification over the past 30 years, continuous blood purification has made great achievements in the treatment of SAP; however, there are still many controversies, and further studies are needed to explore therapeutic effect and mechanism. This article reviews the studies on continuous blood purification in the treatment of SAP in recent years and elaborates on its therapeutic mechanism, treatment mode, and treatment effect.

Effect of anisodamine combined with blood purification on pulmonary fibrosis, serum matrix metalloproteinase-9 and matrix metalloproteinase 1 levels in patients with paraquat poisoning / 中国医师杂志

Objective@#To investigate the effect of anisodamine combined with blood purification on pulmonary fibrosis and levels of serum matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase 1 (TIMP1) in patients with paraquat poisoning.@*Methods@#From March 2013 to February 2017, 84 patients with paraquat poisoning admitted to our hospital were enrolled in the observation group (anisodamine + blood purification) or control group (blood purification ), 42 cases in each group. The curative effect, indexes related to pulmonary fibrosis, serum MMP-9 and TIMP1 levels were compared between the two groups. The incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and intensive care uni (ICU) admission time were recorded.@*Results@#There was significant difference (P<0.05) in the total effective rate (88.1% vs 69.0%) and the high-resolution computed tomography (CT) score after 7 days of treatment (8.4±0.9 vs 12.3±1.4) between the observation group and the control group. At the same time, the serum levels of hyaluronic acid and type Ⅳ collagen in the two groups showed an upward trend with significant difference (P<0.05). After 1 day of treatment, the serum levels of MMP-9 and TIMP1 in the observation group reached a peak, then gradually decreased, with significant difference (P<0.05). The incidence of ALI/ARDS in the observation group and the control group (11.9% vs 31.0%) and the duration of ICU treatment [(10.2±3.2)d vs (13.2±2.8)d].@*Conclusions@#For patients with acute paraquat poisoning, the combination of anisodamine and blood purification can down-regulate the expressions of MMP-9 and TIMP1 and delay the progression of pulmonary fibrosis, thus improving the clinical therapeutic effect.

Effect of anisodamine combined with blood purification on pulmonary fibrosis, serum matrix metalloproteinase-9 and matrix metalloproteinase 1 levels in patients with paraquat poisoning / 中国医师杂志

Objective To investigate the effect of anisodamine combined with blood purification on pulmonary fibrosis and levels of serum matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase 1 (TIMP1) in patients with paraquat poisoning.Methods From March 2013 to February 2017,84 patients with paraquat poisoning admitted to our hospital were enrolled in the observation group (anisodamine +blood purification) or control group (blood purification),42 cases in each group.The curative effect,indexes related to pulmonary fibrosis,serum MMP-9 and TIMP1 levels were compared between the two groups.The incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and intensive care uni (ICU) admission time were recorded.Results There was significant difference (P ＜ 0.05) in the total effective rate (88.1％ vs 69.0％) and the high-resolution computed tomography (CT) score after 7 days of treatment (8.4 ± 0.9 vs 12.3 ± 1.4) between the observation group and the control group.At the same time,the serum levels of hyaluronic acid and type Ⅳ collagen in the two groups showed an upward trend with significant difference (P ＜ 0.05).After 1 day of treatment,the serum levels of MMP-9 and TIMP1 in the observation group reached a peak,then gradually decreased,with significant difference (P ＜0.05).The incidence of ALI/ARDS in the observation group and the control group (11.9％ vs 31.0％)and the duration of ICU treatment [(10.2 ± 3.2) d vs (13.2 ± 2.8) d].Conclusions For patients with acute paraquat poisoning,the combination of anisodamine and blood purification can down-regulate the expressions of MMP-9 and TIMP1 and delay the progression of pulmonary fibrosis,thus improving the clinical therapeutic effect.

Advance in hemofiltration for severe acute pancreatitis / 国际外科学杂志

The treatment of severe acute pancreatitis (SAP) is a difficult clinical problem.Hemofiltration has been used in the treatment of SAP for more than 20 years.Hemofiltration can clear excessively activated inflammatory factors of blood and block systemic inflammatory response syndrome (SIRS),while maintaining water-electrolyte balance.It plays an more and more important role in the treatment of SAP.At the same time,the application of hemofiltration in the treatment of SAP is also controversial and requires further study.This paper will summarize recent advances in hemofiltration for SAP so as to achieve better application of hemofiltration in clinical practice.

A mathematical calculation model of replacement fluid and citric acid infusion in continuous veno-venous hemofiltration / 中华危重病急救医学

Objective To design a mathematical calculation model for better understanding and grasping the logical problem of replacement fluid and citric acid anticoagulant infusion in continuous veno-venous hemofiltration (CVVH). Methods ① Parameter definition: A, B, and T were respectively called the main part of pre-replacement fluid, 5% sodium bicarbonate solution, and 4% sodium citrate infused before filter. And a and b were respectively called the main part of post-replacement fluid, and 5% sodium bicarbonate solution infused after filter. ② Logic conversion:The liquid in back terminal (Z) was artificially divided into two parts. One (X) was the original residual plasma after filtration. The second (Y) was the part excluding the plasma, including the left part of pre-replacement fluid with sodium citrate, and the post-replacement fluid. ③The mathematical formulas of liquid volume and electrolyte concentration at X, Y and Z in unit time were listed according to the principle of CVVH and the screening coefficient of filter for different substances. ④The calculation formulas were entered into Excel form, and a mathematical calculation model was made, and a simulation calculation with examples was carried out. Results An Excel model was established by inserting the calculation formulas of volume, electrolyte, and total calcium at X, Y and Z. And it was found that the concentration of Na+, K+, Cl-, HCO3- at Y point remained unchanged only when A, B and (or) a, b was kept in same side and proportion even with the change of blood flow and other parameters without sodium citrate as anticoagulant. Once any of the parameters (such as blood flow, replacement fluid volume, etc.) were adjusted in other infusion methods (such as different ratios, different directions of the same year, etc.), the calculation results at Y would vary, and the electrolyte concentration at Z would change accordingly. A change of dilution model or parameter would result in the change of the electrolyte concentration at Y and Z with sodium citrate as anticoagulant. The concentration of total calcium scarcely changed no matter in what model and parameters. Conclusions All kinds of infusion ways could be included in the Excel model. The infusion results of all kinds of infusion matching could be intuitively evaluated. It is helpful for the medical staff to make a logical analysis and risk prediction in CVVH.

Combination of extracorporeal membrane oxygenation and in-line hemofiltration for the acute hyperkalemic cardiac arrest in a patient with Duchenne muscular dystrophy following orthopedic surgery: a case report / 대한마취과학회지

BACKGROUND: Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy that anesthesiologists can encounter in the operation room, and patients with DMD are susceptible to complications such as rhabdomyolysis, hyperkalemic cardiac arrest, and hyperthermia during the perioperative period. Acute onset of hyperkalemic cardiac arrest is a crisis because of the difficulty in achieving satisfactory resuscitation owing to the sustained hyperkalemia accompanied by rhabdomyolysis. CASE: We here report a case of a 13-year-old boy who had multiple leg fractures and other trauma after a car accident and who had suffered from acute hyperkalemic cardiac arrest. He was refractory to cardiopulmonary resuscitation and showed sustained hyperkalemia. With extracorporeal membrane oxygenation and in-line hemofiltration, he recovered from repeated cardiac arrest and hyperkalemia. CONCLUSIONS: Combining ECMO and in-line hemofiltration might be a safe and effective technique for refractory hyperkalemic cardiac arrest and rhabdomyolysis in patients with DMD.

A calcium-containing replacement solution simplified regional citrate anticoagulation in continuous venovenous hemofiltration for children after congenital heart surgery / 中国小儿急救医学

Objective To simplify regional citrate anticoagulation(RCA) in continuous veno-venous hemofiltration (CVVH) with a calcium-containing replacement solution for children after congenital heart surgery.Methods The clinical data of 20 children with RCA in CVVH after congenital heart surgery were retrospectively analyzed.All cases were divided into two groups:the traditional group(12 cases) using a calcium-free replacement solution and the modified group(8 cases) using a calcium-containing replacement solution.The blood gas data,plasma ionic calcium,total calcium/ionic calcium ratio,circuit survival time,calcium supplement and the number of adjustments of replacement fluid formula were compared between the two groups after CVVH.Results During RCA-CVVH,serum HCO3-,pH,systemic ionized calcium,and the ratio of total calcium / ionic calcium were higher than those before RCA-CVVH,but all in normal range.There was no significant difference in circuit survival time between two groups [(50.5 ± 2.3) h vs.(48.8 ± 4.7)h,respectively,P ＞0.05].Calcium supplementation in the traditional group was significantly higher than that in the modified group[2.5％ calcium chloride supplementation was(0.43 ±0.11) ml/(kg-h) in the traditional group and(0.13 ± 0.17) ml/(kg-h) in the modified group].The number of replacement solution adjustment was (2.7 ± 1.1) times in traditional group,while the modified group did not change the replacement formula.Conclusion RCA using a calcium-containing replacement fluid in hemofiltration,can reduce the supplement of calcium and the times of the replacement solution adjustment,which is easy to operate.It can be used safely,effectively and conveniently in CVVH children after congenital heart surgery.

Survey on the prevalence of continuous blood purification in Chinese pediatric critical care / 中华儿科杂志

Objective@#To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China.@*Methods@#A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected.@*Results@#From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83).@*Conclusions@#CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis.

The effect of continuous veno venous hemofiltration on neutrophil gelatinase-associated lipocalin plasma levels in critically ill patients with acute kidney injury / 中华内科杂志

Objective To evaluate the effect of continuous veno venous hemofiltration (CVVH) on neutrophil gelatinase associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI).Methods Critically ill patients with AKI who needed CVVH and admitted to Department of Critical Care Medicine of Peking Union Medical College Hospital were enrolled prospectively from January 2015 to June 2015.AN69 membrane filters were used for CVVH.Prefilter,postfilter,and plasma NGAL measurements were taken at 10 mins,4 hours and 8 hours (T 10 min,T 4 h,T 8 h) after CVVH.The influence of membrane filter and volume management on NGAL level was analyzed.Results Forty patients were recruited.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 22.9±7.0.The sequential organ failure score (SOFA) was 12.1±2.9,and ICU mortality was 27.5％.During CVVH,there were no significant differences in NGAL levels between prefilter [T 10 min:39.3 (24.8,62.4)μg/min;T 4 h:(45.1±23.2)μg/min;and T 8 h:(45.5±22.4)μg/min] and postfilter [T 10 min:33.5 (25.1,60.7)μg/min;T 4 h:(44.2±24.3)μg/min,and T 8 h:(45.9±22.4)μg/min] (P＞ 0.05 for all).Compared with the survival group[310.0(162.0,588.0) μg/L],plasma NGAL level in T 10 min [684.0(270.0,944.0) μg/L] was significantly higher in death group (P=0.033).After fluid balance correction,T 4 h [603.4(484.8,620.2) μg/L] and T 8 h [590.2(475.9,749.4) μg/L] plasma NGAL levels in death group were significantly higher than those in the survival group [T4 h:419.5 (227.5,552.4)μg/L;T 8 h:400.7(196.1,517.4) μg/L] with statistical significance (P＜0.01 for both).Conclusions During CVVH,AN69 membrane filter does not have significant effect on plasma NGAL level in critically ill patients with AKI.After volume balance correction,plasma NGAL level could be used as an effective indicator in these patients.

Effect of continuous blood purification on peripheral blood monocyte membrane binding CD14 expression and inflammatory response in patients with traumatic sepsis / 中华创伤杂志

Objective To investigate the effect of continuous blood purification (CBP) on peripheral blood monocyte membrane CD14 (mCD14) expression and inflammatory response in patients with traumatic sepsis Methods A retrospective case control study was conducted on the clinical data of 50 patients with severe sepsis after trauma treated between January 2015 and December 2016. There were 34 males and 16 females, with an average age of 45.37 years (range, 16-73 years). Patients were divided into CBP group (25 cases) and non-CBP group (25 cases) according to whether they agreed to receive CBP treatment. The peripheral blood samples were collected at 0, 12, 24, 48, and 72 hours after treatment, and the mCD14 and leukocyte elastase (HLE) expressions were detected by flow cytometry and by ELISA, respectively. The peripheral blood mononuclear cells were isolated from the two groups 24 h after treatment and cultured in vitro. The variations of mCD14 expression in mononuclear cells were measured at 4, 8, 12, 24, 48, and 72 h after stimulation with lipopolysaccharide (LPS). The expression levels of tumor necrosis factor (TNF) -a, interleukin (IL) -6, and IL-10 in mononuclear cells were detected by ELISA. Results At 12, 24, 48, and 72 hours after treatment, the leukocyte elastase levels in the two groups were lower than those before treatment (P ＜ 0.01), and the decrease in CBP group was significantly greater than that of non CBP group(P＜0.01). At 12, 24, 48, and 72 hours after treatment, the mCD14 levels in both groups were up-regulated before treatment (P ＜0.01), and the increase in CBP group was significantly greater than that of non CBP group (P ＜ 0.01). The mCD14 expressions before treatment, 4 h after treatment, and 8 h after treatment in CBP group were all higher than those in non CBP group at the same time points. At 4, 8, 12, 24, and 48 hours after the re-stimulation with LPS on the mononuclear cells in both groups, the levels of TNF-α and IL-6 in CBP group were significantly higher than those in non-CBP group (P ＜0.01), and there was no significant difference in IL-10 levels between the two groups (P ＞0.05). Conclusions CBP treatment can increase monocyte mCD14 expressions through eliminating inflammatory factors and pro-inflammatory mediators and reducing HLE directly or indirectly in patients with traumatic sepsis. When the body is stimulated again, its anti-inflammatory response ability is markedly stronger than that of patients who have not received CBP treatment.

Therapeutic effect of pulse high volume hemofiltration for treatment of patients with sepsis: a systemic review and Meta-analysis / 中国中西医结合急救杂志

Objective To systematically evaluate the therapeutic effect of pulse high volume hemofiltration (PHVHF) for treatment of patients with sepsis. Methods Databases such as PubMed in American National Medical Library, Holland medical abstract Embase, the Cochrane Library, China National Knowledge Internet (CNKI), China Biological Medical Literature Database (CBM), VIP, WanFang databases, etc. were searched by computer to retrieve randomized controlled trials (RCTs) on PHVHF for treatment of patients with sepsis, and the retrieval time ranged from the creation of database to March 25, 2017. Both groups of patients received conventional treatments, including antibiotics, fluid resuscitation, vasoactive agents as well as other organ function support treatments to maintain the basic vital signs stable. Patients in PHVHF group received PHVHF besides conventional treatment, while the patients in control group received conventional treatment or any other continuous renal replacement therapy (CRRT) mode with PHVHF excluded. The literatures accepted should at least include one of the following changes of outcome indicators, such as overall mortality, the levels of inflammatory mediators eliminated, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, service life of filter, amount of replacement fluids used. Two researchers independently screened literatures, extracted data, and assessed the methodological quality of included studies. Meta-analysis was conducted by using RevMan 5.3 software and the publication bias was evaluated by visually inspecting funnel plots. Results A total of 11 RCTs involving 410 patients met eligibility criteria, of which 204 patients in the PHVHF group and 206 patients in the control group. In the control group 5 RCTs used other CRRT modes, and 6 RCTs applied the conventional therapy. Meta-analyses showed that interleukin-6 [IL-6, standard mean difference (SMD) = -0.80, 95% confidence interval (95%CI) = -1.56 to -0.06, P = 0.04], tumor necrosis factor-α (TNF-α, SMD = -0.78, 95%CI = -1.33 to -0.23, P = 0.006), APACHE Ⅱ scores [mean difference (MD) = -3.80, 95%CI = -5.08 to -2.52, P < 0.000 01] were obviously lower than those in control group, but no significant statistical significance in mortality was seen between the two groups [relative risk (RR) = 0.72, 95%CI = 0.49 - 1.07, P = 0.10]. Further subgroup analyses suggested that compared with conventional treatment group, in PHVHF group mortality (RR = 0.40, 95%CI = 0.16 - 0.95, P = 0.04), IL-6 (SMD =-1.87, 95%CI = -3.58 to -0.16, P = 0.03), TNF-α (SMD = -1.32, 95%CI = -2.24 to -0.40, P = 0.005), and APACHE Ⅱscore (MD = -4.29, 95%CI = -6.02 to -2.56, P < 0.000 01) were significantly decreased; however, only a significantly decreased APACHE Ⅱ score (MD = -2.95, 95%CI = -4.56 to -1.35, P = 0.000 3) was observed in PHVHF group compared to that in subgroup of other CRRT modes. Conclusions Compared with using conventional therapy alone, using PHVHF combined with conventional therapy for treatment of patients with sepsis can more effectively improve their prognosis, and PHVHF can be the efficacious alternatives of other CRRT modes especially the HVHF. However, due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are needed to verify the above conclusion.